Orthostatic intolerance as a potential contributor to prolonged fatigue and inconsistent performance in elite swimmers

Dysautonomia following Lyme disease: a key component of post-treatment Lyme disease syndrome?

Dysautonomia, or dysfunction of the autonomic nervous system (ANS), may occur following an infectious insult and can result in a variety of debilitating, widespread, and often poorly recognized symptoms. Dysautonomia is now widely accepted as a complication of COVID-19 and is an important component of Post-Acute Sequelae of COVID-19 (PASC or long COVID). PASC shares many overlapping clinical features with other infection-associated chronic illnesses including Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Post-Treatment Lyme Disease Syndrome (PTLDS), suggesting that they may share common underlying mechanisms including autonomic dysfunction. Despite the recognition of this complication of Lyme disease in the care of patients with PTLD, there has been a scarcity of research in this field and dysautonomia has not yet been established as a complication of Lyme disease in the medical literature. In this review, we discuss the evidence implicating Borrelia burgdorferi as a cause of dysautonomia and the related symptoms, propose potential pathogenic mechanisms given our knowledge of Lyme disease and mechanisms of PASC and ME/CFS, and discuss the diagnostic evaluation and treatments of dysautonomia. We also outline gaps in the literature and priorities for future research.

Long Duration Ultrasound Combined with Platelet-Rich Plasma Injection for Return to Sport after Soft Tissue Injury: A Single Center Study

Objective

The use of Long-Duration Ultrasound (LDU) and Platelet-Rich Plasma (PRP) treatments to facilitate injury healing and pain relief are typically utilized independently in sports medicine. Our study aimed to investigate the combined regenerative effect of daily LDU with high-concentration single-injection PRP for treating sport-related musculoskeletal injuries.

Methods

In total, thirty-five competitive athletes (n=35) with grade II sprains and strains and tendinopathies injured during sport and unable to continue to play were sequentially administered PRP (n=20, 20.4 yoa, 18 male, 2 female) or PRP+LDU (n=15, 20.27 yoa, 14 male, 1 female). In the PRP treatment group, each subject was treated with a single injection of PRP consisting of 1.28 billion platelets/mL under ultrasound-image guidance to the injury site. The PRP+LDU treatment group received the same PRP injection procedure with a 14-day, 4 hr per day, 18,720 J ultrasound treatment applied over the injection site. The Numeric Ration pain Scale (NRS, 0-10), Range of Motion (ROM, 0-100%), Clinical Strength numeric score (CS, 0-5), and time of injury to return to sport (days) were measured at baseline and Return to Play (RTP). The global health improvement score (GROC -7 to +7) was measured upon RTP.

Results

All patients completed rehabilitation and returned to the sport after debilitating injuries. PRP+LDU returned athletes to play 21.33 days quicker (p<0.0001), decreased injury pain by 0.88 NRS points (p=0.0086), and improved patient global health by 1.28 points GROC (p<0.0001) over PRP treatment alone (95% Confidence interval, 11.26 to 31.40 days faster). There were no significant differences in strength (p=0.498) or range of motion (p=0.8581) improvement between PRP and PRP+LDU at the RTP or baseline patient demographic variables.

Conclusion

Adding LDU at-home treatment to PRP injection therapy significantly reduces the time to return to sport, increases pain reduction, and improves overall health for patients recovering from sport-related injury. The daily LDU treatment facilitates and enhances regenerative medicine therapies such as PRP.